Provider Demographics
NPI:1730294182
Name:BURNS, JENNIFER LEA (LMHP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEA
Last Name:BURNS
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S 4TH ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5200
Mailing Address - Country:US
Mailing Address - Phone:402-379-2455
Mailing Address - Fax:
Practice Address - Street 1:125 S 4TH ST
Practice Address - Street 2:SUITE 215
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5200
Practice Address - Country:US
Practice Address - Phone:402-379-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2898101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025201100Medicaid